Local holes exist in KanCare networks

Andy Marso

Wednesday

Dec 26, 2012 at 3:39 PM

State data shows the three managed care companies set to take over Kansas Medicaid services next week have holes in their Shawnee County provider networks.

While all three companies have strong primary care physician networks, Sunflower State Health Plan had no providers within 25 miles of Shawnee County in nine of 22 medical specialties when the data was collected Dec. 10.

The other two managed care companies had fewer holes locally. Virginia-based Amerigroup had no providers in nephrology, physical medicine/rehabilitation and plastics and reconstructive surgery within 25 miles of Shawnee County. Minnesota-based United Healthcare had no neonatologists in that range.

Miranda Steele, spokeswoman for the Kansas Department of Health and Environment, said the managed care organizations will bear the burden of ensuring specialist care.

"The MCOs must guarantee access to specialists, so if a specialty is not available in their network in a specific area, they must make arrangements for members to access those services out of network," Steele said.

The three companies have been building provider networks since this summer, when they were announced as the recipients of contracts for KanCare, Gov. Sam Brownback's managed care plan for Medicaid.

Steele said her department continues to monitor the networks. Consumer advocacy groups have their eye on them as well.

"This has been certainly an ongoing conversation we at the Kansas Health Consumer Coalition have been having both with partners and members of the (Brownback) administration, trying to meet on a monthly basis with key individuals in charge of KanCare implementation," KHCC executive director Anna Lambertson said.

United Healthcare spokeswoman Alice Ferreira said the networks are constantly changing and her organization responds to member needs.

The state's provider network data is available at http://www.kancare.ks.gov/download/KanCare_MCO_Network_Access.pdf.

Steele said provider networks have grown since the document was last updated and will continue to grow after KanCare goes live.

Lambertson said the sign-up rate may be increasing, noting the KanCare provider manuals handed out by each company were only finalized about two months ago.

"I was on a lot of those stakeholder (conference) calls, and routinely providers on those calls said, ‘Look we don’t have the provider manual yet, we’re not going to sign anything until we have that in our hands,’ " Lambertson said. "I know that was definitely something holding up the expansion of provider networks."

Brownback and other members of the administration say KanCare is imperative to stem the burgeoning costs of Medicaid in anticipation of federal budget cuts. They estimate it will save the state more than $1 billion during the next five years without cutting benefits, limiting enrollment or lowering provider compensation rates.

They also say the managed care companies will improve patients' health by coordinating their services to deliver "the right care at the right time."

Nearly all of the state's 380,000-some Medicaid recipients were auto-assigned to one of the three companies this month. Starting Jan. 1, 2013, they will have 90 days to switch.

Steele said the companies must honor "all plans of care, prior authorizations, and established provider-member relationships" during that 90-day period, even if the providers in question aren’t in network.

Ferreira said that should give Medicaid recipients peace of mind.

"No one’s in any immediate or eminent danger of having no access to their doctor," Ferreira said.

Lambertson said Medicaid consumers should contact their providers to find out if they are in the networks or if they plan to join.

As of Dec. 10, the unit wasn’t in United Healthcare or Sunflower State's networks.

"We continue to have talks with them," Ferreira said.

Ferriera said "nothing has been finalized" between her company and Stormont-Vail, but the hospital could join the network during the 90-day choice period.

That would be welcome news for Kansas Action for Children president and CEO Shannon Cotsoradis.

Cotsoradis said the neonatology provider maps suggest the state may be moving too fast in the transition to managed care.

"If we had a bit more time perhaps the network would be in better shape than it appears to be when it comes to specialty care," Cotsoradis said. "We certainly hope the burden will fall on the MCOs and not on the families, particularly when it comes to high-risk infants."

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